Reduction in Retrospective Claim Timeframe for Medicare Bulk Bill Claiming Services

By Máté Rudas

medicare bulk bill claiming

📰 News Update
Source: Department of Health and Aged Care – Reduction in timeframe to submit bulk billed claims (PDF)


What’s Changing for the Medicare Bulk Bill Claiming?

On 5 September 2025, the Department of Health and Aged Care announced an important change to the Medicare bulk bill claiming timeframe and the process for lodging retrospective bulk billed Medicare claims.


From this date forward, the time limit for submitting bulk billed Medicare Benefits Schedule (MBS) and Child Dental Benefits Schedule (CDBS) services and claims has been reduced from two years to one year from the date of service.

This amendment to the Health Insurance Act 1973 and the Dental Benefits Act 2008 shortens the period in which providers can submit, amend or resubmit claims for eligible bulk billed services through Medicare, including lodging a Medicare application for bulk bill claim form when necessary.

“From 5 September 2025, the timeframe to submit bulk billed Medicare claims will be reduced from 2 years to 1 year from the date of service.”
— Department of Health and Aged Care, 2025


How Does This Affect You?

It’s important to note that this change:

  • ✅ Applies only to bulk billed MBS or CDBS services rendered on or after 5 September 2025.
  • ❌ Does not apply to bulk billed services rendered before this date — those still fall under the previous 2-year rule.
  • ❌ Does not affect Inpatient Medical (Medicare + Health Fund), DVA, Overseas Visitor or Student Health Cover or Compensation claims — these remain governed by their respective contracts or the 2-year retrospective claiming period.

Implications for ICU and Hospital Practice

For Intensive Care physicians and public hospital billing teams, this change should have minimal impact on day-to-day billing operations.
Most ICU services are billed either through:

  • In-hospital medical (Health Fund) claims, or
  • DVA, OSHC/OVHC, Compensation and Insurance Claims

However, if your ICU or health service occasionally bulk bills self-funded private patients, be aware that from 5 September 2025, you’ll only have 1 year to lodge, amend or resubmit bulk bill Medicare claim forms.

This is equally relevant if you or your department regularly raise claims via retrospective audits – and are operating under the 2-year framework.


Recommended Actions for Medicare Bulk Bill Claiming

While this policy currently applies only to bulk billed services, it may signal a broader future tightening of retrospective claiming timeframes.


For this reason, now is a good time to review your audit and retrospective billing practices to ensure you do not miss legitimate billing if the 1-year rule expands to other claim types.

This is particularly relevant to public hospital Intensive Care Units and Hospital Billing Departments, where long delays in claim submission and followup can be common.

For a detailed overview of the relevant issues and how retrospective billing fits within the hospital billing workflow, see our related article:
🔗 Private Patient Billing in Public Hospitals – Understanding the Billing Cycle


References

Department of Health and Aged Care – Reduction in timeframe to submit bulk billed claims (September 2025)


Disclaimer

This blog is provided for educational and general informational purposes only and does not constitute legal, medical, or financial advice. While every effort has been made to ensure accuracy, billing requirements under the Medicare Benefits Schedule (MBS) are complex and subject to change. Clinicians should always consult the official MBS, relevant hospital policies, or seek independent professional advice before making billing decisions. While we use reasonable effort to ensure that our overview articles are accurate, current and complete, we do not represent, warrant, or guarantee (to the maximum extent permitted by law) their accuracy, currency, or completeness or imply that they are applicable to your individual situation. ClaimLogic accepts no liability arising from for actions taken based on the content of this article.

Máté Rudas

Dr Rudas is the Director and Founder of ClaimLogic. 

He is Senior Staff Specialist at Royal Prince Alfred Hospital in Sydney. His clinical interests include critical care ultrasound, advanced haemodynamic monitoring and mechanical cardiorespiratory support. He is a member of the CICM Ultrasound Special Interest Group, an examiner for the ASUM DDU (Crit Care) and works as part of the NSW ECMO Retrieval Service.

Other interests include medical billing, clinical informatics and health facility design. Roles include Clinical IT lead at NBH and ICU clinical co-lead for the RPA ICU redevelopment project. 

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